Objective: To evaluate the outcome of patients with irresectable hilar cholangiocarcinoma undergoing orthotopic liver transplantation (OLT) and to identify the prognostic factors that could influence survival.
Methods: The data of 18 patients who underwent OLT for irresectable hilar cholangiocarcinoma between June 2003 and October 2010 were analyzed retrospectively. There were 12 male and 6 female cases with median of 52 years(range from 34 to 65 years).Fifteen patients underwent modified piggyback liver transplantation, 2 patients underwent classical orthotopic liver transplantation and 1 patient underwent living donor liver transplantation. Data were evaluated regarding tumor size, pathologic stage, overall survival, recurrence rates and prognostic factors.
Results: OLT with lymphadenectomy was received by 18 patients with hilar cholangiocarcinoma. Median time until tumor recurrence was 20.5 months(range from 6.0 to 33.0 months). Seventeen patients died during follow-up.Of these, 14 patients died from recurrent or metastatic diseases, 2 patients died from multiple organ dysfunction syndrome during peri-operative period, and one patient died from other cause. The median survival time was 29.5 months(range from 3.0 to 84.0 months). The overall survival rate and recurrence-free survival rate at 1, 3, and 5 year were 16/18, 8/18, 1/18 and 13/18, 2/18, 1/18, respectively.Lymph node metastases had a statistically significant negative impact on overall survival. The 1, 3, and 5 year survival rates were 6/7, 1/7,0 and 10/11, 7/11, 1/11 (P < 0.05) in lymph node-positive and lymph node-negative patients.
Conclusions: Acceptable survival rates can be achieved by OLT for irresectable hilar cholangiocarcinoma without lymph node metastases.Strict patient selection plus multimodal chemoradiation therapy prior to OLT are recommend for patients with lymph node metastases.